The risk factors for perioperative blood transfusion in open liver resection: a retrospective cohort study

Purpose: Liver resection is the current treatment for hepatic neoplasms but may be associated with intraoperative hemorrhage and the need for blood transfusions. The aim of this study is to identify the risk factors for predicting the requirement of a perioperative blood transfusion in open liver resection. Methods: A total of 808 consecutive patients who had undergone elective open liver resection from 2006 to 2017 were retrospectively reviewed using the database. Baseline characteristics and intraoperative data were collected. Perioperative blood transfusion was defined as the transfusion of allogenic packed red cells during surgery and the 48 h following surgery. An analysis of logistic regression was used to determine the independent risk factors for blood transfusion in open liver resection. Results: Three hundred and seventy-seven patients (46.7%) received perioperative packed red cell transfusions. The independent risk factors associated with perioperative blood transfusion included ASA classification >2, preoperative anemia (Hb<12 g/dl for women, Hb<13 g/dl for men), thrombocytopenia (platelet count<100x10(3)/mm(3)), albumin<3.5 g/dl, largest tumor size >4 cm., major liver resection, and surgeon experience performing <50 cases of major open liver resection. Conclusion: Preoperative risk factors may be utilized to assess and predict patients who require perioperative blood transfusions following liver resection. Modifiable risk factors may also be treated prior to surgery. Furthermore, patient blood management and methods to minimize blood loss and blood transfusions during surgery should be implemented in patients who require high-risk transfusions.